Srikureja Wichit, Kyulo Namgyal L, Runyon Bruce A, Hu Ke-Qin
Division of Gastroenterology, Loma Linda University Medical Center, Loma Linda, CA, USA.
J Hepatol. 2005 May;42(5):700-6. doi: 10.1016/j.jhep.2004.12.022.
BACKGROUND/AIMS: The aim of the present study was to compare MELD score, Child-Turcotte-Pugh (CTP) score, modified Maddrey's Discriminant Function (DF) score, and the related variables in predicting in-hospital mortality of patients with alcoholic hepatitis.
A retrospective chart review and statistical analyses were done on 202 patients consecutively admitted for alcoholic hepatitis from 1997 to 2002 at the Liver Unit at Rancho Los Amigos Medical Center.
Twenty-nine patients died during the hospitalization. Admission MELD score (OR 1.1, P=0.005), first week MELD score (OR 1.2, P<0.0001), and first week increase in MELD score (OR 1.3, P<0.0001) were independently associated with in-hospital mortality. The area under the receiver operating curve (AUC) for the first week increase in MELD score was higher compared to CTP score (P=0.0004) and DF score (P=0.059). Moreover, the first week MELD score >/=20 had the best sensitivity (91%) and specificity (85%) compared with admission or first week change MELD score.
The present study indicates that in patients with alcoholic hepatitis, admission, first week, and first week change in MELD score are significantly independent predictors for in-hospital mortality. MELD score is a more valuable model than CTP or DF score in patients admitted with alcoholic hepatitis.
背景/目的：本研究旨在比较终末期肝病模型（MELD）评分、Child-Turcotte-Pugh（CTP）评分、改良Maddrey判别函数（DF）评分以及相关变量对酒精性肝炎患者住院死亡率的预测价值。
对1997年至2002年期间连续入住兰乔洛斯阿米戈斯医疗中心肝病科的202例酒精性肝炎患者进行回顾性病历审查和统计分析。
29例患者在住院期间死亡。入院时MELD评分（比值比[OR] 1.1，P = 0.005）、第一周MELD评分（OR 1.2，P < 0.0001）以及第一周MELD评分的升高（OR 1.3，P < 0.0001）与住院死亡率独立相关。与CTP评分（P = 0.0004）和DF评分（P = 0.059）相比，MELD评分第一周升高的受试者工作特征曲线下面积（AUC）更高。此外，与入院时或第一周变化的MELD评分相比，第一周MELD评分≥20时具有最佳的敏感性（91%）和特异性（85%）。
本研究表明，对于酒精性肝炎患者，入院时、第一周以及第一周MELD评分的变化是住院死亡率的显著独立预测因素。在酒精性肝炎患者中，MELD评分比CTP或DF评分更具预测价值。
